OptiPush Wheelchair Training System Wheelchair users are over twice as likely to be obese as people in the general population. The solution to obesity in the wheelchair user population is the same as it is in the general population, a healthy diet and regular exercise. The limited availability of wheelchair accessible cardiovascular exercise equipment may be contributing to lack of regular exercise in this population. Obesity among wheelchair users has led to secondary conditions such as heart disease and upper extremity (UE) pain and injury. Over half of the wheelchair user population has developed UE pain and injury. Body weight has been found to be a predictor of UE injury, with heavier users being more prone to injury. In addition to losing weight, training users such that they develop the strength and skills to push with less frequent, long, smooth strokes is currently recommended to help protect them from developing injuries. The OptiPush Wheelchair Training System (WTS) is a wheelchair-accessible treadmill that allows the wheelchair user to improve cardiovascular fitness, exercise capacity, strength and propulsion technique. In Phase I of the project, a proof of concept prototype was developed and evaluated by three wheelchair users during a 6-week exercise study. The wheelchair is secured to the treadmill by a dynamic tether system, which allows the wheelchair to move freely along the length of the treadmill but prevents it from tipping over, veering off course or rolling off the rear. Subjects were able to independently and safely use the OptiPush prototype and experienced significant improvements in cardiovascular health. The goals in Phase II of the project are to improve the design of the OptiPush treadmill and develop a commercial version that can be made available to individual users, gyms and rehabilitation centers. Push cadence and distance biofeedback will be provided to encourage users to use less frequent, long, smooth strokes. As a result of this project, wheelchair users will have increased access to cardiovascular fitness equipment and biofeedback training tools, enabling them to maintain cardiovascular health and improve their propulsion technique. PUBLIC HEALTH RELEVANCE: OptiPush Wheelchair Training System Relevance to Public Health Manual wheelchair users are at considerable risk of being obese, developing cardiovascular disease and developing upper limb overuse injuries. Two preventative measures are to exercise regularly and follow propulsion technique guidelines. This project will develop a wheelchair accessible treadmill with propulsion biofeedback that enables wheelchair users to independently and safely exercise while improving their propulsion technique.